Transplanted Kidney:

Please examine the Abdominal System of this 44 year old lady who has been
referred by her GP with abdominal pain

Clinical Examination:

Classical Signs Additional Signs

- Hockey-Stick Scar in Iliac Fossa - Features suggesting underlying

- Fullness in region Iliac Fossa aetiology (diabetic finger prick,
- Bruit may be present malar flush, etc)
- - Features of immunomodulatory
- Features of previous renal therapy –
replacement therapy – Peritoneal o Cushings features
dialysis scars in abdomen, AV (steroids),
fistulae in arms (comment if o Gum Hypertrophy
currently being used – thrill, (Cyclosporin),
evidence of needling) o Skin Cancers
(Tacrolimus or
Azathioprine)
Common discussion topics:
Common causes of renal failure and Investigations
What complications are associated with end stage renal disease?
When is dialysis indicated?
What are the criteria for renal transplantation?
Common side effects of immunomodulatory drugs.

Quick Revision:
Common causes of renal failure: Diabetes mellitus, Hypertensive nephropathy,
Glomerulonephritis, Pyelonephritis, Polycystic kidney disease.

Investigations Management

Urine: glucose, 24 hour protein, Renal replacement therapy:

haematuria, microscopy for casts,
microbiology
Blood tests: FBC, calcum levels,
protein electrophoresis, auto
antibodies, complement levels,
cryoglubulins
Renal USS
Kidney biopsy
Haemodialysis
Peritoneal Dialysis
Renal Transplant
Manage complications of renal failure:
Meticulous fluid balance
Erythropoietin for anaemia
Vitamin D
Side effects of therapy